Functional Medicine Tests Demystified

Welcome to The Perfect Stool: Understanding and Healing the Gut Microbiome. This is your host, Lindsey Parsons. Today I'm going to be talking about all the different functional medicine tests I use and when and why I choose certain ones, from stool tests to blood to urine and even hair tests that cover things like organic acids, fatty acids, amino acids, heavy metals, and nutrient levels. On a side note, if you happen to be one one of the wonderful people who has tried my new supplement, Tributrin Max, on Amazon and it's working for you, I'd very much appreciate if you submitted a review. If it's not working for you, you can reach out at help@tributrinmax.com for advice on how best to take it. And if you haven't yet followed or subscribed to the show, be sure to do so. And if you want to get transcripts of the podcast, pop over to my website, HighDesertHealthCoaching.com, and sign up for my newsletter. You'll also get my free ebooklet, Finding Your Root Cause Through Stool and Organic Acids Testing, when you sign up. If you haven't yet done my quiz on which stool test would help you get to your root cause, you can find a link in the notes and take that. Now onto the show. So since this is a show about gut health, I'll start with the different stool tests I use. And while I'm talking, it might be useful to pause the podcast for a second and go to my Rupa Health Lab store, which I'll link in the show notes, and open up the test I'm talking about so that you can see what I'm referring to. On every test, after selecting it, if you scroll down and select View Report, which is right under Sample Report, you can see an example of the test report. So to start with, the primary stool test I use is the GI-MAP from Diagnostic Solutions. Like most functional medicine stool tests, the GI-MAP uses polymerase chain reaction, or PCR testing, to quantify the microbial DNA present in your stool. This is the newer technology, newer than culture, which favors the microbes that grow well in culture and is no longer a valid way to measure bacteria in stool given the newer PCR technology that's available. The GI-MAP, like other tests, covers commensal bacteria and bacteria that may overgrow, including Methanobrevibacter smithii, one of the two primary microbes involved in IMO or intestinal methanogen overgrowth, and Dysulfovibrio species, which are overgrown in hydrogen sulfide SIBO or small intestine bacterial overgrowth, as well as bacterial and viral pathogens, quantities of the two major phyla in the gut, Bacteroidetes and Firmicutes, and their ratio, yeast and fungi, parasites, and intestinal health markers, including markers for fat in the stool, pancreatic enzymes, beta glucuronidase, which relates to estrogen dominance and when high puts you at risk of breast and colon cancer, and fecal occult blood, secretory IgA, which is your gut immune defense system, and anti-gliadin IgA, which is a marker of gluten intolerance, and eosinophil activation protein, a marker of gut inflammation, and calprotectin, a marker of active inflammatory bowel disease. Pros for the GI-MAP are that among the bacteria it tests, it includes Helicobacter pylori, or H. pylori, along with its virulence factors, which indicates whether the strain you have could cause stomach cancer or ulcers, whereas this is an add-on test for some other companies and doesn't include the virulence factors with those companies. You can also get the H. pylori profile as a separate test, incidentally, from Doctor's Data for $131. And the other big pro is that the GI-MAP overall is lower cost at $381 from my Rupa Health lab store, or a little less for my active clients if they go directly through me, which is a lot less than some of the other functional medicine stool tests. The biggest cons for me about the GI-MAP are that it doesn't measure the different short-chain fatty acids in stool. It doesn't compare the levels of the other important phyla, in particular Proteobacteria and Actinobacteria. And because Lucy Maling, one of my gut health mentors, sent a stool sample split in half to Diagnostic Solutions and got two very different results on calprotectin. So the reliability of that marker is somewhat in question, although arguably one part of the stool could concentrate certain things. So it's hard to be sure whether this actually questions the reliability of that marker for that lab. I've generally seen that it correlates well with clients who have diagnosed IBD. The Genova GI Effects Comprehensive Profile is the second stool test that I'd be most likely to order if doing a functional medicine stool test. And I'd be more likely to choose this one if there were no symptoms of H. pylori, like reflux, nausea, or constipation, or if someone had done a prior PCR stool test for H. pylori and it was negative. And I might choose it as well if I suspected there was an issue with producing sufficient butyrate, like when I see loose stool, unresponsive to antimicrobials or antibiotics, or in the case of IBD. It's also one that Lindsey Parsons has found reliable in her split stool experiments. With the GI FX, there is a 3-day stool sample option and a 1-day stool sample option for the same price. So if a client is game for taking stool samples for 3 days, that's definitely gonna be more accurate. The main differences between the GI FX and the GI-MAP are that on the GI FX, there's 5 markers for fecal fat versus 1 on the GI-MAP, plus all of the short-chain fatty acids. Which is helpful for assessing if there was a gut barrier issue in the colon as well as dysbiosis. There's also a marker for the products of protein breakdown indicative of incompletely digested protein in the colon, which could come from low stomach acid, for example. And the GI FX shows you the relative abundance of all the major phyla bacteria, yeast, and archaea in the gut, which I like because often people have overgrowth of proteobacteria. There's still a culture section on GI Effects, which feels a bit dated. So I basically ignore that section unless it happens to catch yeast, in which case it's helpful because if anything is found growing in culture, they do provide a sensitivity section of that microbe to various antibiotics and antimicrobial herbs. So that can help guide which herbal preparation to choose. And then the GI Effects also includes reflex subtyping for Blastocystis hominis because only subtype 7 is considered pathogenic and subtype 4 has even been shown to be beneficial in studies. So this might be a good follow-up stool test for someone who originally did the GI Map and got a positive result for Blastocystis. The GI Effects will run you $507 in my lab shop. So as I said, it is more expensive. So that's one reason I usually recommend the GI Map for most people. So those are the two primary stool tests that I use, but sometimes rarely I come upon someone who, whose symptoms all scream H. pylori and nothing else, like if they have no bloating, but they're constipated and have reflux or nausea, or also if money is a real issue., or if they have a diagnosed ulcer, for example. In that case, I may choose to recommend just the H. pylori profile from Diagnostic Solutions or use it as a follow-up test after working with someone on H. pylori. Then sometimes I choose to use SIBO breath testing with people, perhaps when their primary symptoms scream SIBO to me but nothing else, like with lots of bloating and then either loose stool or constipation, and reflux might also be an issue. If they have loose stool, I'll recommend the Trio Smart as it's the only test that includes all 3 gases—hydrogen, methane, and hydrogen sulfide—especially if they visceral pain, meaning pain in the gut, and sulfury-smelling stool. That's $349 if you get it directly from the manufacturer, and I have a link for that in the show notes. And then if someone's stool is loose but doesn't smell at all, then I generally assume it's likely hydrogen, and a just a plain SIBO, EMO breath test either with lactulose or glucose is best. That's $261 in my lab shop, but honestly you can find it cheaper elsewhere if you're just using the glucose as a substrate for measuring. However, you can get it with the lactulose from my shop shop, as they have a physician review service in the ordering that allows for lactulose because it's only available with a prescription in the U.S. And glucose and lactulose, by the way, are the substances that people drink before taking the breath test. Lactulose is definitely more useful if you're looking at EMO, intestinal methanogen overgrowth, and constipation, as EMO can be anywhere in the digestive tract and glucose is absorbed early in the digestive tract. But if someone has loose stool and bloats immediately after eating then glucose may be the better choice. If they have alternating constipation and loose stool, then lactulose is probably the better choice. But I will say that I don't use breath testing that often. I generally use a combination of a stool test, symptoms, and history to decide whether it's likely a case of SIBO or EMO or neither. Now, I should mention that there is also something called the FoodMarble, which is an at-home breath testing machine, which I'll link to in the show notes. For someone with super recalcitrant recurrent SIBO or EMO, I often wish I had suggested they order this at the beginning, as it would be more helpful because you can retest and the equipment includes 2 glucose kits and costs about as much as one SIBO or EMO test. But you can't get lactulose without a prescription if you're using the Food Marble in the US, so it's not great for EMO in the large intestine unless you're not in the US and can get lactulose. And you never quite know who's going to have a tough case of EMO until you're usually one stool test and probably a couple rounds of antimicrobials into the problem. One other nice thing about the Food Marble is you can also get a food intolerance test kit for the other things you can test on breath, like lactose, fructose, sorbitol, and inulin, which many people are also sensitive to. And finally, when someone has recurring symptoms of SIBO that seem to come back after trying antibiotics like Rifaximin or antimicrobial herbs, generally with diarrhea, loose stool, then I also think of the IBS-Smart test, which tests for the antibodies for vinculin and CDTB, which tells you whether your IBS or SIBO is the results of food poisoning and will be an ongoing issue for you, necessitating prokinetics and lifestyle interventions to help you manage it and delay recurrences., and you can get that for $220 directly from the manufacturer. I'll also briefly mention that I put the Grain Zoomer test by Vibrant Wellness in my Rupa Lab Shop because I have a number of clients who are eating strictly gluten-free diets and have gotten a positive anti-gliadin IgA on the GI Map. In this case, it's usually indicative that there's cross-sensitivity to grains. So if they're positive and there's no gluten slipping in, then I recommend this test to see if they're reactive to other grains. That's $304. And if they're eating grain-free too but are eating some dairy, then I may recommend the Dairy Zoomer test by Vibrant Wellness instead to see if they're reacting to dairy. I don't generally do food sensitivity testing, but sometimes there's clearly inflammation in the gut that's coming from something. And if you get that positive anti-gliadin IgA and you know it's food mediated, then you know there's some cross-reactivity which could be from other grains or dairy. And that one is also $304. Then another test I use frequently is the Organic Acids Test. I typically use the Mosaic version, which changed its name recently from Great Plains Lab. Episodes 74 and 77 of my podcast go into great depth on interpretation of this test, so if you want more details, check those out and I will link to them in the show notes. I usually add that in for gut health clients if I hear symptoms of fungal overgrowth or Candida, like heavy antibiotic use, a turn in health after antibiotics, a white coating on the tongue, frequent UTIs or urgency, or vaginal yeast infections, or household mold issues, because there are multiple markers on the Organic Acids Test for fungal overgrowth. I also add in the Organic Acids Test, or O.A.T., if I hear about anxiety or depression, as there are markers for neurotransmitters. It also covers markers in the urine of bacteria, and specifically Clostridia overgrowth, as well as oxalates, Krebs cycle metabolites, markers for energy production from fatty acids, carbs, and proteins, and markers for the status of various B vitamins, vitamin C, and CoQ10. And then markers of detoxification, including two markers that assess glutathione sufficiency, which is your master antioxidant. So it's also useful for people with low energy, chronic fatigue, or toxic exposures, poor liver function, that sort of thing. And that's 337 in my Rupa Lab store. Now, for clients who have health issues that go above and beyond gut stuff and maybe some light mental health issues like chronic fatigue any type of autoimmunity, any type of inflammatory bowel disease, fibromyalgia, or complex longstanding health issues, I often suggest the NutrEval. That's N-U-T-R-E-V-A-L. There are two versions, the FMV or plasma, and I think the plasma is preferable because it's the most accurate for amino acid levels. The NutrEval is both a blood and urine profile that evaluates over 125 biomarkers. It includes an organic acids test, the Genova Organics version, which is similar to the Mosaic OAT, but only has 3 markers for yeast and fungal overgrowth. And then on top of that, you get all of the amino acids, all of the fatty acids. So you can see if people are low in omega-3s or over-supplementing with them, and you sometimes find they're low in omega-6s. It also has some of the minerals, including copper, zinc, magnesium, potassium, manganese, and selenium measured in the best way recommended, as well as heavy metals, including lead, mercury, arsenic, and cadmium., and it has markers for all of the B vitamins, vitamin D, CoQ10, and markers of oxidative stress that relate to fat-soluble and water-soluble antioxidants. So it's an amazing all-over body test that helps you figure out where functionally something is going wrong in the body. And that's $507 in my Rupa shop. So for an extra $170, you get a lot more stuff over an organic acids test. The last test that I've used with people before is the Doctor's Data Hair Elements Test, which measures all the essential elements, meaning minerals in hair. And then all of the potential toxic elements, 17 in all. I would use this with, say, extreme hair loss, or with known or suspected toxic exposures, or perhaps as a follow-up check for removal of toxins we've been working on that were identified on the NutrEval. I actually have a podcast coming up on minerals and hair and tissue mineral analysis, so stay tuned for that one. The nice thing about this test is at $137, it's very inexpensive, but it gives you a lot of information. So those are the primary tests that I use with clients, just to give you an overview. You can order them yourself in my lab store, but if you're thinking of working with me, I give clients a slight price break. So best to have me put in the order for you. And I know this was all very complex, so if you're signed up for my newsletter, I'll send out the transcript link in a week to my blog. So if you want that, make sure you're getting my newsletters by going to highdeserthealthcoaching.com and signing up. And if you're looking for help with your gut health or overall health or specific issues, that's my specialty. You can set up a complimentary 30-minute breakthrough session with me by going to the link in the show notes. And if you'd like to support the podcast, you can find supplements at a discount from my Fullscript dispensary or using my affiliate links to eVitamins, Bulk Supplements, or Amazon. And if you'd like to connect with me online, you can follow my High Desert Health Facebook page, join my Gut Healing Facebook group, or find me on Twitter, Instagram, TikTok, and Pinterest. And links for those are in the show notes. Thanks for joining me today, and here's wishing you all the perfect stool.